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ECG Abnormalities_Part 07

Monday, October 11, 2010

A 27 year old female with a history of HIV infection presents to the emergency room with a complaint of increased dyspnea on exertion and lower extremity edema over the past 6 months. She denies chest pain, paroxysmal nocturnal dyspnea or orthopnea.

Her temperature is 37.0, blood pressure 90/50, heart rate 110, respiratory rate 20. She has large V waves in her jugular venous pulsations, a III/VI pansystolic murmur at the left lower sternal border which gets louder with inspiration, and a right ventricular S4 heart sound is heard. A pulsatile liver is palpated.

Her ECG and chest x-ray are given below:

What are the ECG findings and the abnormality in the chest Xray?


ECG ANSWER

The ECG findings include:
1) Sinus tachycardia
2) RVH with strain pattern

Chest XRAY ANSWER

The patient's clinical presentation is consistent with severe pulmonary hypertension. Her ECG revealed RVH which results from pulmonary hypertension. Her chest x-ray shows enlarged pulmonary arteries and an enlarged right ventricle in the absence of pulmonary edema. Her physical exam showed findings consistent with severe tricuspid valve regurgitation which included large jugular V waves, the pansystolic murmur at the tricuspid listening post that increases with inspiration (Carvallo's sign), the right ventricular S4 heart sound indicating RVH, and a pulsatile liver indicating severe regurgitation into the hepatic venous bed.


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19 Responses to ECG Abnormalities_Part 07

  1. Anonymous Says:
  2. ECG finding is RAD.RBBB. Rt atrial hypertrophy sins tachecardi.hart beat 120(m)
    chest x-ray > cardiomegaly in atrial side .congesion in chest fild

     
  3. Anonymous Says:
  4. right ventrical infarct maybe, we nne to explore v7 v8 v9 lead

     
  5. Anonymous Says:
  6. ECG : right axis , st depression in V1,2,3 with negative T(that may be normal variant), R wave dominant in V1. lower extremity edema the past 6 months with pulsatile liver leads to heart failure so the x ray heart silhouette should be enlarged. Mustn't be A.P.E. due to x ray. One guess is right heart infarction, another option could be congestive pericarditis. Enzymes and U/s scan are needed.

     
  7. Anonymous Says:
  8. cogestive cardiac failure with mitral valvular heart disease......

     
  9. Jesse Custer Says:
  10. pericarditis congestiva...

     
  11. dr baloch Says:
  12. tricuspid regurgitation with right sided heart failure explains the signs ecg shows tachy with right axis deviation and right ventricular hypertrophy whli xray shows cardiomegaly

     
  13. Anonymous Says:
  14. Congestive Cardiac Failure + Tricuspid Regurgitation + Pulmonary Hypertension
    ECG: Sinus Tachycardia, RAD, RVH, Right Ventricular strain (T-wave abnormalities in V1-V3
    CXR: Increased CT Ratio,Right heart enlargement, Prominent pulmonary artery

     
  15. Anonymous Says:
  16. cor pulmonale

     
  17. Anonymous Says:
  18. ECG: RT vent. enlargement (pul HTN) &inf. wall ischemia
    X ray: Bil hilar L.N.

     
  19. Hossam Fayed Says:
  20. ECG: Sinus tach,P pulmonale, RAD, Right ventricular strain, probably Right ventricular infarction or pulmonary embolism as prominent R in V1 and depressed ST?? to be correlated with lab Ix

    CXR: Biatrial and Right ventricle enlarged. middle right lung zone shadow.

     
  21. Anonymous Says:
  22. Tromboembolismo pulmonar e insuficiência tricúspide aguda.

     
  23. Anonymous Says:
  24. Tricuspid Regurgitation leading to prominent V wave in JVP and other clinical findings.On ECG p-pulmonale, Rt axis deviation and signs of Rt Ventricular Hypertrophy with strain pattern and X ray showing Cardiomegaly with Prominent Rt atrial bulge is most likely of Rt heart failure secondary to Tricuspid Regurgitation.

     
  25. Anonymous Says:
  26. ECG S1 Q3 T3
    Rwave in V1
    T inversion in V1, V2
    Xray show enlarge heart shadow Rv

     
  27. Anonymous Says:
  28. cogestive cardiac failure with mitral valvular heart disease

     
  29. Anonymous Says:
  30. right side heart failure with pulmonary hypertension

     
  31. Anonymous Says:
  32. This patient has classic symptoms of right heart failure. The EKG is consistant with this.... RAD, RAE, RVH with strain. Tricupspid regurg. You may also fine that the patient has cannon (A-waves).

     
  33. Anonymous Says:
  34. RVH with strain (Tall R-wave in V1 and inverted TW's in V1 - V3)
    RAE with prominent peaked TW's in lead II
    Rightward axis of approximately 100 degrees

    DX: Right-sided heart failure secondary to tricuspid valve regurge causing increased CVP.

     
  35. Anonymous Says:
  36. How good of a tool can this be with so many different interpretations? I think I'll stick with cardiologists in group practices & request 2nd & 3rd opinions.

    Nurse Wixon

     
  37. Anonymous Says:
  38. Just wondering, cor pulmonalae really?
    Could it be that she got her HIV from sharing needles to inject drugs which totally screwed the tricuspid valve (maybe throwing some septic emboli to cause some mild cor-pulmonalae).

    BUT the MAIN cause of all the s/s (RVH + regurg) being tricuspid valve destruction 2nd to infective endocarditis of the T-valve and NOT cor-pulmonalae which is merely red herring in this case?

    That also would sync with the lack of pulmonary edema cos there might not be significant pulm hypt with pulm-regurg to begin with.

    PS: I'm no expert in either X-ray not ECG reading. But does this story hold?

     

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